Wound Care


Published on

Wound care

Published in: Health & Medicine, Business
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Wound Care

  1. 1. Wafer Aldulaimi
  2. 2. Wash the wound Sumerians used beer and oil to the wound Oil –bacteria grow poorly in oil and dressings become non adherent
  3. 3. Honey: Now known to be antibacterial Grease (animal fat): Barrier to bacteria Wound edges were held together with thorns or linen strips soaked in gum (steri strips!) or ant pincers Also bound ulcerating lesions with figs that contain papain( proteinase)
  4. 4. Hippocrates (2500 years ago) wrote of: Washing wound with wine and vinegar (acetic acid) Relieving pressure to avoid cutaneous wounds (pressure ulcers) Described surgical drainage of pus with piece of tin pipe
  5. 5. Aurelius Celsus :Described four cardinal signs of inflammation Rubor, Calor, Dolor and Tumor Believed in keeping wound moist so wound would close Wound cavities were filled with sea sponges ,sometimes soaked in wine or vinegar
  6. 6. Pare’ was official royal surgeon to kings Henry II. Pare’ –cauterized amputation’s with red-hot iron or oil.
  7. 7. Alexander Fleming : penicillin in 1929
  8. 8. Topical products :Hydrocolloids , Hydrogels ,Calcium alginates/hydrofibers , Foams , Starch dressings , Enzymatic debriders Antibiotics Surgical debridement Renewed interest in ancient remedies honey→ Renewed interest in maggots (“Biosurgery” ) Ultraviolet light Laser Hydrotherapy Electrical stimulation Ultrasound Growth factors impregnated dressings
  9. 9. Skin substitutes synthetic and biologic→ Growth factor revolution –actively manipulate wound healing angiogenesis→ Gen therapy Nanotechnology : Drugs directed to specific aspects of wounds , Manipulating of angiogenesis
  10. 10. By time of healing By morphology By etiology
  11. 11. Acute An acute wound is an injury to the skin that occurs suddenly rather than over time. It heals at a predictable and expected rate according to the normal wound healing process
  12. 12. Examples: Surgical wounds (surgical) Traumatic wounds (puncture wounds, cuts, abrasions, burns, frostbite, chemical burns , radiation etc.) Infection-related wounds
  13. 13. Chronic Wounds A chronic wound develops when any acute wound fails to heal in the expected time frame for that type of wound, which might be a couple of weeks or up to 12 weeks in some cases.
  14. 14. The black, yellow and red wound
  15. 15. Black necrotic wound
  16. 16. Yellow wound
  17. 17. Red wound
  18. 18. Decubitus (pressure ulcers / sores) Venous ulcer (venous-related wounds) Arterial ulcer (ischaemic wounds) Arterio-venous ulcer cruris (mixed wounds) Diabetic ulcers (ulcers caused by diabetes mellitus) • Infected wounds • Immunological wounds • Cancer wound
  19. 19. Etiology In 1860, Florence Nightingale wrote : “If he has a bedsore, it is generally the fault not of the disease but of the nursing.” The main cause is unrelieved pressure to a location of skin on the body. This constant pressure inflicts damage by decreasing the area’s blood supply and traumatizing the skin.
  20. 20. • Stages
  21. 21. • Treatment – Debridement of all necrotic tissue – Maintenance of a favorable moist wound environment – Relief of pressure – Addressing host issues such as nutritional, metabolic, and circulatory status
  22. 22. • Venous ulcers are the most common type of ulcers occurring in the lower limbs. • Venous insufficiency  leakage of : – Fibrinogen perivascular cuffing that affects oxygen exchange  loss of subcutaneous fat – Leakage of hemoglobin  brownish pigmentation
  23. 23. This combination lead to characteristic skin changes called lipodermatosclerosis
  24. 24. Treatment Compression therapy + wound care
  25. 25. • Symptoms of peripheral ischemic changes : – Intermittent claudication – Rest pain – Night pain – Diminished or absent pulses, – Decreased ankle-brachial index Poor formation of granulation tissue – Dryness of skin – Hair loss ,Scaling – Pallor – The wound itself usually is shallow with smooth margins, and a pale base and surrounding skin
  26. 26. Ankle brachial pressure index = 0.9 - 1,2
  27. 27. Treatment Revascularization + Wound care
  28. 28. • These ulcers cause considerable pain and distress for patients and pose a difficult wound-management problem for health professionals. • Many patients have significant oedema due to venous insuficiency that needs to be controlled but also have some degree of arterial disease (atherosclerosis) where compression bandaging is contraindicated.
  29. 29. Treatment • Reduced compression strength • No compression when ankle pressure below 80 mmHg or ABI below 0.7 • If the ankle pressure is below 60 mmHg or the ABI is below 0.5, revascularization is recommended. • Wound care
  30. 30. Etiology • 60 to 70% are due to neuropathy • 15 to 20% are due to ischemia • 15 to 20% are due to a combination of both
  31. 31. • The neuropathy is both sensory and motor, and is secondary to persistently elevated glucose levels • The loss of sensory function allows unrecognized injury to occur from ill-fitting shoes, foreign bodies, or other trauma • The motor neuropathy or Charcot foot leads to collapse or dislocation of the tarsometatarsal or metatarsophalangeal joints • There is also severe micro- and macrovascular circulatory impairment
  32. 32. Charcot foot
  33. 33. Treatment • Adequate blood sugar levels • Wound care • Charcot foot: splinting and non weight bearing • Prevention: regular check , non compressing shoe , etc.
  34. 34. Traditionally, wound microbiology has been described in three phases: – Contamination refers to the presence of bacteria that are not multiplying. – Colonization refers to bacteria which are growing within the wound but not causing tissue damage. Infection : Bacteria causing tissue damage and clinical signs of infection.
  35. 35. Treatment • Debridment • Antibiotics • Consider biofilm !
  36. 36. Biofilm • It is an aggregate of microorganisms embedded within a self- produced matrix of extracellular polymeric substance (EPS). • Bacteria embedded within biofilms are resistant to both immunological and non- specific defence mechanisms of the body. • Treatment is by mechanical removal
  37. 37. • Vasculitis
  38. 38. • Pyoderma gangraenosum
  39. 39. Treatment 1. Corticosteroids and immune modulators 2. Gentle wound care 3. Avoid surgery ! It make it worse !
  40. 40. Either from a primary skin cancer or as metastasis
  41. 41. Treatment 1. Elective Surgery 2. Elective Radiation 3. Elective chemotherapy 4. Wound care